Many With Terminal Cancer Still Getting Routine Screens

Many patients with incurable cancer are still being screened for common cancers, although these tests are unlikely to provide any benefit, researchers from Memorial Sloan-Kettering Cancer Center in New York City have found. Specifically, many patients diagnosed with advanced lung, colorectal, pancreatic, gastroesophageal or breast cancer are still undergoing the ordeal of routine breast, prostate and colon cancer screening, said the researchers. Not only might these patients suffer from invasive procedures like colonoscopies near the end of life, the researchers said, but they face the unnecessary risk of additional tests, biopsies and psychological distress resulting from the detection of new malignancies.

"For patients living with advanced cancer, cancer screening should not be a routine procedure," said lead researcher Dr. Camelia S. Sima, an assistant attending biostatistician. "Patients living with advanced malignancies and their doctors should engage in a realistic conversation about the risks and benefits associated with cancer screening in face of a severely limited life expectancy," she added. The report is published in the Oct. 13 issue of the Journal of the American Medical Association. For the study, Sima's team collected data on 87,736 Medicare patients aged 65 years or older with advanced lung, colorectal, pancreatic, gastroesophageal or breast cancer, whose data was reported in the Surveillance, Epidemiology, and End Results (SEER) tumor registries.

These patients were followed from their diagnosis, between 1998 and 2005, until they died or to the end of 2007. To compare the findings to a control group, the researchers also collected data on 87,307 similar Medicare patients without cancer, who were matched with the other individuals for age, race, sex and SEER data. In both patient groups, Sima's team looked at the rates of mammograms for breast cancer, Pap tests for cervical cancer, prostate-specific antigen (PSA) tests for prostate cancer and endoscopy for colon cancer. The investigators found that among women with advanced cancer, 8.9 percent had a mammogram, compared with 22 percent of those without cancer; and 5.8 percent of the cancer patients had a Pap test, compared with 12.5 percent of those without cancer.